Black men who have sex with men (BMSM) often share common experiences of racism, sexual prejudice, judgment and displacement from their families, churches and communities. Their everyday stressors can be further complicated by negative encounters within medical institutions, according to a study led by an Emory physician. The study findings are published in the January/February issue of the Journal of the National Medical Association.

Prior studies have shown that one of every 50 African-American males is infected with HIV. Black men who have sex with men in the United States are disproportionately affected by HIV, and suffer from rates of HIV infection in some cities that rival those in sub-Saharan Africa.

The most prevalent estimates for HIV infection in the BMSM population is at 33% for 15-29 year olds in some major metropolitan cities. Astoundingly, up to 93% of these men are unaware of their HIV status, according to a 2002 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention.

"It's important to study how the healthcare experiences of BMSM play a role in the HIV epidemic because medical facilities are the place where most of this population have access to HIV testing," says lead researcher David J. Malebranche, MD, MPH, an instructor of medicine in the Emory University School of Medicine.

"Oftentimes, BMSM who don't identify as 'gay' will not access community-based organizations that traditionally offer HIV testing services because they fear negative stigmatization by association. But medical providers and other staff play a key role in how comfortable BMSM feel in coming to healthcare facilities and being honest regarding their sexual behavioral risk for HIV," he says.

Dr. Malebranche and fellow researchers at the New York City Department of Health and the Mailman School of Public Health at Columbia University formed eight focus groups of BMSM living in New York and Atlanta in early 2001. Eighty-one men were recruited through community-based organizations and health service providers. Led by a facilitator, the men discussed the external and internal barriers that contributed to their healthcare experience.

The researchers found that the social context of racial and sexual displacement the men felt in their daily lives were also carried into their experiences in the health care system.

"Black men who sleep with men have to cope with the social stigma of being both black and homosexual," Dr. Malebranche says. "Not only do they feel disconnected from mainstream white culture, but there is also a social isolation from the black community. It leaves them with a disjointed sense of self."

Dr. Malebranche notes that medical providers can be a safe haven for these men and can serve to help BMSM empower themselves to cope and turn healthcare into a positive experience.

"A positive medical experience can help black homosexual men communicate more truthfully and realistically with each other, and can also help them better evaluate their own HIV risk factors," says Dr. Malebranche. " Other studies have shown that knowledge of HIV positive status is an important positive predictor of improved condom use, which will ultimately slow down the epidemic."

The study also discusses external barriers to medical care such as money, lack of insurance, perceived lack of confidentiality, and an impersonal medical system.

Not to be overlooked, however, are the internalized barriers to healthcare that surfaced in the focus group sessions. Issues such as distrust, racial and sexual stigma, and fear of medical services were identified as barriers to accessing services and open communication.